Abstract P163: LVO Screening and Transfer During Covid-19 Surge in Louisiana

Abstract

Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 in the Greater New Orleans Area and quickly spread throughout the state. We sought to determine if LVO screening and door in-door out (DIDO) among patients who screened positive for large vessel occlusions (LVO) deteriorated. Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared LVO screening and transfer efficiency during Q1 and Q2 2020 with Q3 and Q4 2019. Results: Patients presenting within 24hr of last seen normal declined by 11%. The proportion arriving by ambulance increased (50.6% vs 40.7%, p<0.0001). Screening for LVO increased (84.4% vs 77.0%%, p<0.0001). Use of Vision-Aphasia-Neglect assessment increased (74.6% vs 66.2%%, p<0.0001). The proportion screening positive for LVO insignificantly decreased (23.1% vs 26.0%, p=0.1233). The median time from door in to transfer request was stable (63min during both time periods). The median time from transfer request to departure increased (58min vs 48min). The DIDO increased by 24 minutes (135min vs 111min). Delay due to achieving acceptance in hub center and secondary transfer ambulance were the most common reasons documented for prolonged DIDO. Discussion: Louisiana experienced a reduction in acute stroke presentation during COVID-19. Screening for LVO actually improved during this time, but DIDO was compromised due to problems securing transfer acceptance and secondary ambulance service. Earlier identification and initiation of secondary transfer for patients screening positive for LVO should help improve efficiency in delivering acute stroke therapy.